Pediatric emergency medicine trisk 4562 4562
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may not appear for minutes to hours, tissue damage from vesicants occurs within
a few minutes, and agent that penetrates the skin is far less amenable to
decontamination than the agent that has not yet been absorbed.
Patient decontamination has two important purposes: prevention or
minimization of continuing absorption of agent into the patient and prevention of
secondary exposure of healthcare workers. By preventing absorption of a lethal
dose of agent, immediate decontamination can be the most important lifesaving
action available for a chemical casualty. This process would ideally occur at the
scene; however, in a large-scale terrorist incident, it is far more likely that some
victims will self-transport to the ED. A special decontamination and treatment
area in the decontamination corridor outside or adjacent to the ED markedly
facilitates casualty processing and management, and accreditation agencies have
mandated that all hospitals provide such decontamination capacity.
FIGURE 132.5 A rapidly deployable outdoor decontamination facility.
Capability for thorough decontamination must be available quickly with little
setup time. Many models have been proposed, but most authorities recommend
an outdoor facility with multiple patient stations, arranged so that parallel lines of
ambulatory and nonambulatory patients may be processed simultaneously ( Fig.
132.5 ). An outdoor facility is more capable of handling multiple patients and
may make the use of copious water irrigation easier; however, it may be
challenging to protect victims from inclement weather in temperate climate
zones, an issue especially important in the management of young children. Thus,
